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John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Bobby Gladd recently pointed out this interesting YouTube video of Dr. Joseph Kvedar speaking at the 2010 Connected Health Symposium. In the video Dr. Kvedar makes some interesting observations about humans and their relationships with devices and how that applies in healthcare. He calls it emotional automation. Check out the video if you have a few minutes.

I find this concept really intriguing. At a very practical level (since my heart is very practical), I couldn’t help but draw the parallel from what Joseph Kvedar said and the idea of the online doctor’s visit. There’s so many reasons that this should be successful and so many situations where an in person visit doesn’t matter.

I’ll share a quick personal experience. Being around doctors and working with doctors as much as I do, I’ve had occasion where I was feeling sick and didn’t have the time to go and see my regular doctor. In one instance, I was leaving for Hawaii the next morning and it was 4 PM the day before. Basically, no time to get to my doctor.

As it so happened, I was in the office of a doctor that I worked with. I mentioned the issue and told him my symptoms. He then asked if I wanted him to write me a script. I was a bit taken a back by the request. I certainly wanted his help, but shouldn’t we have gone in and done the routine. You know the routine. The one where the doctor listens to your breathing and heart (or whatever they’re really listening to). Feels around your neck. Looks in your mouth and ears.

Instead, this doctor went straight to the script. Turns out I’ve since learned that in many cases that doctor routine just isn’t really needed. In fact, many times it’s just done for the sake of the patient and not part of the diagnosis at all. Oh the dirty little secrets of healthcare. If you’re a doctor you already know all about this I’m sure. And certainly I’m not advocating removing the patient visit all together. Just in many cases it’s just not needed.

Of course, my point isn’t necessarily advocating a certain treatment method of not. I’m not a doctor and I don’t claim to be. I’m just sharing what I’ve heard other doctors say. What I am suggesting is that for this change to happen, there’s going to have to be a change of mentality by the patient as much as the doctor.

Dr. Kvedar describes well in the video above that we’re capable of relationships with technology. We can change our behavior and adapt to these types of changes. It will just need the right amount of education and technology to make it happen. I know some EMR vendors have patient portals, but I haven’t seen many that have dove in head first to the online visit model. Probably because the reimbursement model for online visits is still lagging behind.

Lots of really interesting things to chew on in this discussion. I’ve really just begun the conversation. I have a feeling the comments on this post are going to be intense.

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I know that many of you don’t read all of the past comments made on this site. So, I’m sure many of you missed when DonB asked Bobby Gladd the following question:Could you explain your statement at the end of the fifth concern: “I would have added another MU criterion: require working with the RECs as a condition of incentive money eligibility;”

Bobby, from this REC blog, offered the following well thought out answer:

HHS is spending nearly a billion dollars on us RECs, yet we then have to go out and “recruit” providers, doing months of cold-call sales?

That just opens the government up to right-wing charges that Obama is simply blindly throwing money around at cross-purposes.

Many vendors and VARs see us as “competition,” which, in my view, is why we’re seeing some of the RECs doing “preferred EHR vendor” deals — basically trying to ensure that they don’t get cut out of the picture. Were I a viable vendor in a REC state that had excluded me, I might want to consider suing. It reeks of potential conflict-of-interest. Moreover, what about the true interest of the clinician? (Which is why we are officially and assiduously “vendor neutral.”)

Why should a practice work with us? Because we have broad and deep expertise available, soup-to-nuts, at a pittance of the cost of private commercial consultants.

It just begs the question of why RECs are even necessary. Maybe we’re not. Maybe docs can go it alone, or pay commercial consulting rates (that would eat up all their incentive money and then some). However, having decided that RECs are a value-adding thing, I fail to see the wisdom in making us optional.

Many of the RECs are going to fail. They won’t even get to demo their implementation/adoption support chops, they will fail because of the recruiting resistance, and will have burned through most of their initial HHS funding, and will have to start laying people off (I won’t be allowing mold to accrue on my CV).

To date, the leading REC in terms of recruitment is Qualis. Halfway through the expected recruitment period, they are at 9.2% of goal, notwithstanding a Code Red All-Hands-On-Deck recruitment effort.

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I’ve been meaning to write a post linking to BobbyG’s blog for a while and just never got around to it. If you follow the comments on here, you’ll have seen many of BobbyG’s comments as well. The thing that first struck me about Bobby was his sincere and thoughtful comments on the challenges that the RECs face. Here’s some of his thoughts on REC Challenges:

Critics bemoan a lack of prior HIT deployment and QI experience among some REC awardees (as well as the heterogeneity of business models);

While 60 REC contracts have thus far been awarded, with the newly chartered RECs frantically ramping up to meet the rather compressed Stage One Meaningful Use incentive payment timelines, both the requisite Meaningful Use reporting criteria and the EHR (Electronic Health Record) certification regulations remain unresolved at this writing. The cart is seriously out in front of the horses in many respects;

The anticipated huge and short time-frame new demand for HIT installs may well overwhelm the capacity of HIT vendors, resulting in lengthy, problematic implementation queues (not to mention a severe shortage of qualified installation, training, and support personnel);

Notwithstanding that HHS is spending hundreds of millions of dollars on REC contracts, physicians and hospitals are not required to engage REC services in order to qualify for federal incentive payments. Consequently, RECs are having to spend significant time and money hawking their services (the polite term being “enrollment.” I did not know when I signed on that I would be required to do what amounts to hastily and minimally trained cold-call sales). Moreover, REC services are not fully subsidized, the upshot of which is often skeptical “we’ll pass” pushback, especially in light of the hyperbolic claims of virtually all major EHR vendors “guaranteeing” that their products will get the provider to MU (with the glossed-over disclaimer, well down in the fine print”When Used As Directed”);

At this writing, the aggregate Final Rule for MU criteria is still under HHS consideration, with myriad professional stakeholder groups arguing for relaxation of both the compressed compliance timelines and the all-or-nothing approach, countered by a broad array of equally vocal consumer/patient advocacy organizations arguing for MU criteria adoption “as-is” as set forth in the Interim Final Rule.

I would have added another MU criterion: requireworking with the RECs as a condition of incentive money eligibility;

The relatively sparse per-provider federal REC funding may force the RECs to focus simply on assisting their client physicians with hitting the MU criteria in pursuit of the incentive reimbursements — to the practical exclusion of broader and more sustainable, internalized quality improvement efforts;

There is to be a “Health IT Research Center” funded by HHS and intended to “gather relevant information on effective practices from a wide variety of sources across the country and help the Regional Extension Centers (RECs) collaborate with one another and with relevant stakeholders to identify and share best practices in EHR adoption, effective use, and provider support. The HITRC will build a virtual community of shared learning to advance best practices that support providers’ adoption and meaningful use of EHRs.”

It is not even slated to be up and running until FY2012.

I think most of these points hit the nail on the head. RECs are in for some major challenges. It will be interesting to watch those that creatively confront those challenges and those that fold under the pressure of it all. I still stand by my opinion that they could be a tremendous force for good or bad. Considering there are so many RECs all over the US, I’m sure we’ll have plenty of both types.

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

In a recent comment by Bobby Gladd (check out his REC Blog), he makes a really interesting connection between the need for healthcare payment reform and EHR adoption. Here’s his comment:

I would just observe that, absent significant payment reform (I won’t be holding my breath), there’s a very real problematic barrier to effective EHR use if we don’t change the basic paradigm. For example, fundamental to the concept of the “patient-centered medical home” trial initiatives now getting underway is the argument that primary care docs should properly be seeing no more than 8-10 patients per day (e.g., think about the typical hour attorney consult visit), that the customary 25-30 pts/day is driven by the need to bill, to keep the doors open; that roughly half of outpatient visits are of marginal to nil clinical value.

I and one of my REC colleagues did a clinic assessment visit the other day. We interviewed 4 docs, one of whom was a severe Dr. NO!” on the topic of HIT. His beef was basically a “productivity loss” complaint, i.e. that seeing mostly older, complex problem list pts (he’s Internal Med) made it nigh impossible to effectively chart electronically in within the scheduling constraint.

Now, perhaps with a lighter, more rational daily patient load (and more extensive EHR training) he might come around and truly “adopt.”

I consulted with an attorney a couple of years ago regarding legal guardianship over my dementia-addled (now late) Dad. The initial hour cost me $300. The entire deal ended up costing about $4,000.

A physician, however, is supposed to take in myriad data and make a comparably expert decision in 15-30 minutes — and hope he/she can eventually get reimbursed a relative pittance.

It’s crazy.

So, OK, where are we? We’re facing a current and projected shortage of perhaps 40-50,000 primary care docs, and under PCMH theory we propose to cut their pt volumes in HALF ore more so they can provide better care? All while bringing tens of millions of the previously uninsured into the (non-ER) system under Obamacare reform.

Right.

I don’t have a good answer for the skeptical docs who argue that the EMR gold rush is more about billing imperatives and vendor welfare, that the docs’ pt care-analytic needs are a distant 3rd at best.

It’s a vexing circumstance.

My only comment to the “productivity loss” complaint and the EMR gold rush that he refers to at the end is…Maybe they’re looking at the wrong EMRs. Unfortunately, the EMR stimulus does promote mostly the wrong EMR vendors. That’s why the EMR selection process is so important.

Free EMR Newsletter Want to receive the latest news on EMR, Meaningful Use,
ARRA and Healthcare IT sent straight to your email? Join thousands of healthcare pros who subscribe to EMR and HIPAA for FREE!

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